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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Texas Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Care (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Dual Care (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Dual Care (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail-order fills require a $10 copay for a 1-month supply, a $20 copay for a 2-month supply, and a $30 copay for a 3-month supply. For higher-tier medications, the plan transitions to coinsurance for standard pharmacy and mail-order options. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Note that Tier 5 specialty medications are limited to a 1-month supply under these standard options.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care, specialist visits, home health care, and skilled nursing facility services. Inpatient hospital stays require a $1,680 copay per stay with no coinsurance, while outpatient services feature no copays but are subject to a 0% to 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Additional benefits like dental, vision, and hearing services are covered with no deductibles and no copays for many basic services, though select routine exams and treatments require a 20% coinsurance. This plan also includes valuable extras with no copays or coinsurance, such as up to 24 one-way transportation trips per year and a $120 monthly allowance for over-the-counter items. Diagnostic testing and medical equipment are also available with no copays, though a 20% coinsurance applies to durable medical equipment and supplies.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,680 copayment per stay and no coinsurance, subject to prior authorization. Unlimited additional days for acute stays are covered with no copayment, but room upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services covered by Aetna Medicare Dual Care (HMO D-SNP) feature no copays, though coinsurance and prior authorization requirements apply to most services. Beneficiaries will pay a 0% to 20% coinsurance for outpatient hospital and ambulatory surgical center services, and a 20% coinsurance for observation, outpatient substance abuse, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with prior authorization required. Depending on the service, your costs will either be a $110 copay with no coinsurance or no copay with a 20% coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay for ground and air transport, which require prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, but trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $250,000 lifetime limit with no copays or coinsurance.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copays and no coinsurance. Some chiropractic services are covered but routine and other chiropractic services are not covered, while routine podiatry is limited to 12 visits per year.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), offering no copay and no coinsurance for annual physical exams and select supplemental benefits, while other screenings and kidney education require no copay and a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no deductible, offering Medicare-covered exams and fitting evaluations with no copay and no coinsurance, and annual routine exams with a 20% coinsurance and no copay. Up to two prescription hearing aids are covered yearly with no copay and no coinsurance up to $1,250 per ear, though OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no deductibles, offering eye exams and eyewear with no copays, plus a $275 annual maximum benefit for eyewear. A 20% coinsurance applies to routine eye exams, which are limited to one per year, as well as to contact lenses.
Dental Services See details
Aetna Medicare Dual Care (HMO D-SNP) features partially covered dental services, offering Medicare dental care with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,000 annual maximum. While preventive and comprehensive treatments like cleanings and oral surgery are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. There is no coinsurance for diagnostic radiological services, but a 20% coinsurance applies to diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copayment and no coinsurance, although prior authorization is required. The plan allows for SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, which includes chronic illness meal benefits, select wellness screenings, and up to $120 monthly for over-the-counter items. Acupuncture is not covered under this benefit.
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